Researchers have developed a structured, home-based pulmonary rehabilitation framework for Long Covid patients in resource-limited settings, according to a study published in Scientific Reports.
Addressing Long Covid Treatment Gaps in Jordan
Persistent fatigue, respiratory difficulty, cognitive shifts, and diminished functional capacity can linger for weeks or months following a SARS-CoV-2 infection. According to data cited by the study authors, approximately 27% of people in Jordan report persistent symptoms past one month after contracting COVID-19. While hospital-based pulmonary rehabilitation contributes to improving exercise capacity, dyspnea, and quality of life, access remains a hurdle in low- and middle-income countries. Infrastructure shortages, limited personnel, and strained services make center-based models difficult to reach. To close this gap, researchers designed a home-centric framework utilizing basic tools like telephone follow-ups.
Expert Consensus Shapes the Eight-Week Protocol
The study utilized a panel of 15 experts, comprising 12 physiotherapists and 3 rehabilitation physicians, each possessing at least five years of relevant professional experience in pulmonary rehabilitation and Long Covid management. Through a two-phase process, the panel evaluated 97 distinct statements. Of those, 90 items—representing 92.8%—reached consensus regarding importance and feasibility. The seven excluded items were omitted not for lack of clinical value, but due to anticipated application difficulties within local healthcare contexts.
The resulting program spans an initial intensive phase of eight weeks, extendable up to 12 weeks depending on individual progress and needs, followed by a maintenance phase. Patients complete three sessions weekly, lasting 30 to 45 minutes each. Shorter breathing and flexibility exercises can occur daily based on tolerance. Clinicians conduct a baseline evaluation of clinical stability, respiratory function, comorbidities, and symptom load prior to enrollment, with specific attention directed toward post-exertional malaise (PEM).
Prioritizing Symptom-Led Pacing Over Overexertion
A core pillar of the framework is symptom-guided progression rather than standard progressive overload. If activities trigger or worsen symptoms, the physical load is not increased. Instead, patients reduce or temporarily suspend activity, allocate extra recovery time, and resume at a lower baseline later. Monitoring accounts for delayed symptom flares appearing 24 to 48 hours post-exertion. This pacing strategy helps individuals distribute tasks, balance movement with rest, and recognize bodily limits.
The intervention relies on minimal equipment: a stable chair, an elastic resistance band, athletic shoes, the Borg rating of perceived exertion scale, a symptom diary, and a heart rate monitor. Inspiratory muscle training devices and pulse oximeters serve as optional tools when available, with a blood oxygen saturation level below 90% acting as a clinical escalation threshold requiring provider notification.
To bypass digital divide barriers, the framework adopts low-tech remote support through bi-weekly telephone check-ins during the intensive phase. Nurses or therapists use these calls to track adherence, monitor symptoms, and adjust routines. Beyond physical movement, the program incorporates patient and caregiver education on energy conservation, sleep hygiene, and safe exercise practices.
While the protocol establishes a reproducible structure for underserved regions, the study authors emphasize that clinical efficacy requires formal evaluation. Because people with Long Covid were not directly involved in this initial development phase, upcoming implementation trials will test real-world sustainability and patient-reported outcomes.